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Demographics and Inclusivity in CDI
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1.
Please indicate your title/role (check all that apply):
(Required.)
CDI specialist
CDI second level reviewer
CDI lead
CDI supervisor
CDI manager
CDI director
CDI auditor
CDI educator
CDI physician educator
CDI informaticist/analyst
CDI-coding liaison
CDI quality specialist
CDI denials specialist
HIM/coding supervisor
HIM/coding manager
HIM/coding director
HIM/coding professional
Physician advisor/champion
Hospital executive
Consultant
Other (please specify)
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2.
Please indicate the race/ethnicity with which you identify (check all that apply):
(Required.)
African American/Black
East Asian
Hispanic/Latino
Middle Eastern
American Indian/Alaskan Native
Pacific Islander
South Asian
Caucasian/White
Other (please specify)
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3.
Please indicate the gender with which you identify.
(Required.)
Cisgender woman
Cisgender man
Transgender woman
Transgender man
Non-binary
Prefer not to answer
Other (please specify)
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4.
Please indicate the sexual orientation with which you identify.
(Required.)
Heterosexual
Gay/Lesbian
Bisexual
Pansexual
Asexual
Prefer not to answer
Other (please specify)
*
5.
In what region of the country do you work?
(Required.)
Northeast (CT, MA, ME, NH, NY, RI, VT)
North central (IA, IL, IN, MI, MN, NE, ND, OH, SD, WI)
West (AZ, CO, ID, MT, NM, NV, UT, WY)
Middle Atlantic (DE, MD, NJ, PA, DC)
Southeast (AL, FL, GA, KY, MS, NC, SC, TN, VA, WV)
South Central (AR, KS, LA, MO, OK, TX)
Pacific (AK, CA, HI, OR, WA)
Other (please specify if outside U.S.)
6.
What is your perception of ACDIS as an organization, with regard to racial diversity?
Diverse/no concerns
Neutral
Non-diverse/needs improvement
Not sure
Other (please specify)
7.
What is your perception of the CDI profession, with regard to racial diversity?
Diverse/no concerns
Neutral
Non-diverse/needs improvement
Not sure
Other (please specify)
8.
What is your perception of ACDIS as an organization and its values of racial diversity?
Welcoming/no concerns
Neutral
Needs improvement (please add your suggestion below)
Not sure
If you checked "needs improvement" please specify
9.
What is your perception of CDI as a profession and its values of racial diversity?
Welcoming/no concerns
Neutral
Needs improvement (please add your suggestion below)
Not sure
If you checked "needs improvement" please specify
10.
How diverse is the organization in which you work?
Very diverse
Somewhat diverse
Not diverse
Not sure
Other (please specify)
11.
How diverse is the CDI department in which you work?
Very diverse
Somewhat diverse
Not diverse
Not sure
Other (please specify)
12.
How active is the organization in which you work in promoting diversity and inclusion?
Very active
Somewhat active
Not active
Not sure
Other (please specify)
13.
Do you identify as being in a racial minority?
Yes
No
Not sure
Other (please specify)
14.
How well do you feel your race/ethnicity is represented by ACDIS as an organization?
Very well represented
Somewhat represented
Neutral
Not well represented
Other (please specify)
15.
How well do you feel your race/ethnicity is represented in CDI as a profession?
Very well represented
Somewhat represented
Neutral
Not well represented
Other (please specify)
16.
Have you experienced racial/ethnic bias in your CDI career?
Yes
No
Not sure
Please describe if yes
17.
Do you believe that racial/ethnic bias has hindered your CDI career?
Yes
No
Not sure
Please describe if yes
18.
Have you experienced racial/ethnic bias, at an ACDIS event or program?
Yes (please elaborate below)
No
Not sure
Please elaborate if yes
19.
Did you immigrate to the United States?
Yes
No
Prefer not to answer
Other (please specify)
20.
What steps would you recommend ACDIS take to ensure it is racially/ethnically diverse and welcoming?
21.
Are you willing to share your personal story as a person of color in an ACDIS publication (Journal article, ACDIS Podcast, or other)?
Yes
No
If yes, please provide any details.
22.
If you answered yes to the previous question, or if you would like, please provide your contact information (this is optional and you may remain anonymous if preferred, or place "N/A" in any fields you do not wish to include).
Name
Organization name
Title
Email Address
Phone Number
Current Progress,
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